Press releases Monday 8 November to Friday 12 November 2010

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

• (1) Don't clamp umbilical cords straight after birth, urges expert
• (2) Save the Children is BMJ's 2010 Christmas charity
• (3) Hidden costs of applying to medical school will deter poorer students
• (4) Doctors call on governments to use evidence in making clinical decisions
• (5) Calling all journalists to enter the BMJ Group Awards 2011
• (6) Risk of haemorrhagic stroke rises with use of vitamin E

(1) Don't clamp umbilical cords straight after birth, urges expert

(Personal view: Why do obstetricians and midwives still rush to clamp the cord?)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5447

Obstetricians and midwives should wait a few minutes before clamping the umbilical cords of newborn infants so that babies are not harmed by the procedure, argues Dr David Hutchon in an article published on bmj.com today.

Hutchon, a retired consultant obstetrician from the Memorial Hospital in Darlington, says it's time for the UK to follow guidance from the World Health Organisation and the International Federation of Gynaecology and Obstetrics and refrain from early cord clamping.

Despite evidence for the benefit of delayed cord clamping, clinicians in the UK seem reluctant to change their practice, he says, and the UK National Institute for Health and Clinical Excellence (NICE) is not advising them to do so.

One explanation for the apparent resistance of clinicians to follow the evidence is that that cord clamping "has become the accepted norm so much so that delaying clamping is generally considered a new or unproved intervention," he writes.

Yet he argues that "applying a clamp to the cord is clearly an intervention, having the greatest effect when it is done quickly after birth." And he fears that babies might be injured by very early clamping, for example they could experience severe blood loss (hypovolaemia).

He adds that two popular pregnancy information books both imply that delayed cord clamping is the norm and explain the advantage to the baby of delayed clamping.

Hutchon believes that if the need for early cord clamping was removed from NICE’s guideline, "there could be an overnight change in practice."

He concludes: "Clamping the functioning umbilical cord at birth is an unproven intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change."

Contact:
David Hutchon, retired Consultant Obstetrician, Memorial Hospital, Darlington, UK
Email: djrhutchon@hotmail.co.uk

(2) Save the Children is BMJ's 2010 Christmas charity

The BMJ and its sister journal Archives of Disease in Childhood have chosen Save the Children to be their 2010 Christmas charity. The aim this year is to raise at least £30 000. The money donated will support child survival projects in countries such as Sudan, Sierra Leone, and India.

Save the Children chief executive Justin Forsyth explains more in a BMJ article and podcast.

(3) Having severe acne may increase suicide risk
(Research: Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5812
(Editorial: Suicide attempts in people taking isotretinoin for acne)
http://www.bmj.com/cgi/doi/10.1136/bmj.c5866

Individuals who suffer from severe acne are at an increased risk of attempting suicide, according to a paper published on bmj.com today.

The study also finds that an additional risk may be present during and up to one year after treatment with isotretinoin, a commonly prescribed drug for severe acne. However, the authors stress that this additional risk is most likely due to the acne itself, rather than the drug treatment.

Isotretinoin (commonly marketed as Roaccutane, Accutane, Amnesteem, Claravis, Clarus or Decutan) has been used to treat severe acne since the 1980s. The treatment can be effective but there have been reports linking isotretinoin to depression and suicidal behaviour. However studies have had conflicting results, say the authors.

With the hypothesis that acne sufferers are at a higher risk of suicide, regardless of whether they are on isotretinoin, Dr Anders Sundstrom and colleagues from the Karolinska Institute in Sweden, investigated suicide attempts before, during and after isotretinoin treatment for severe acne.

The authors assessed the data of individuals who had been prescribed isotretinoin from 1980 to 1989 and linked these to hospital discharge and cause of death registers from 1980 to 2001.

The data of 5,756 individuals were reviewed and 3,613 (63 per cent) of them were male. The average age of men when they were first prescribed isotretinoin was 22 years and women were 27.

The results show that 128 patients were admitted to hospital following a suicide attempt. The authors also found that between one and three years before starting isotretinoin treatment the number of suicide attempts increased. However the risks were highest within six months after treatment ended.

Sundstrom and colleagues speculate that the increased risk after starting isotretinoin might be because patients whose acne and physical appearance improved following treatment were distraught if there was no improvement in their social life.

They believe it is impossible to say for certain that the continued rise in suicide risk "is due to the natural course of severe acne, or to negative effects of the treatment." They acknowledge that the increased risk could be "as a consequence of exposure to the drug" but believes "a more probable interpretation is that the underlying severe acne may best explain the raised risk."

The authors also stress that attempted suicide is an uncommon event – one first suicide attempt would equate to 2,300 individuals being on isotretinoin – and this assumes that the entire increase in risk was due to the drug, they say.

They conclude that "the most important proactive measure to be taken would be to closely monitor all patients' psychiatric status, not only during treatment, but also for at least a year after treatment with isotretinoin." In addition they say it is not only important to monitor the mental health status of patients receiving isotretinoin but also sufferers of severe acne who are not on treatment.

In an accompanying editorial, two senior researchers in Australia say that "it is difficult to tease out the relation between mental health and isotretinoin because acne itself is associated with psychiatric morbidity, including depression."

Parker Magin and John Sullivan say Sundstrom's research is important given the complexity of the issue and that it is essential that patients who are treated for acne with isotretinoin, especially perhaps those whose treatment is unsuccessful, need to be carefully monitored for depression and suicidal thoughts.

Contacts:
Research: Anders Sundstrom, Pharmacoepidemiologist, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Email: Anders.Sundstrom@Ki.se
Editorial: Parker Magin, Senior Lecturer, Discipline of General Practice, University of Newcastle, New South Wales, Australia
Email: parker.magin@newcastle.edu.au

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc